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Home My WebLink AboutTR-49 BOARD OF TOKEN TRUSTEES Town of'Sou~otd Main Road Southold, New York 11971 DATE: APPLICATION FOR SPECIAL.ICE DAMAGE PERMIT Instructions: Fill out form below and return to above address. You should.hav.e this application approved and returned to you within a week~ 1. Appti¢'ant'$ Name & Address: ~7/L~'.' ~ "~~ 2. Co~t'ractor.'s Name & Address- ~/. Tel. The Purpose of this application: Redriving or replacing openwork dock or openwork pier pi!ing) and mooring piles., removal of d'amaged piling, repair, resetting or replaCement of floating docks, ramps, or decking, all necessitated by ice and storm damage resulting during the winter. THIS PERMIT EXPIRES ON MAY 30 OF TH. IS YEAR 1. No dredging or filling is permitted. Repairs to existing structures shall be limited to replacement of timbers without change in design or dimension. No repair or replacement of bulkheads, is permitted under this permit.. No freshwater or tidal wetlands are to be disturbed under and circumstances~ e A yellow Permit sign provided by this office shall be displayed on the project at all times whil® under replaCement. Original permit number 3 inches high must be permanently displayed on pro'ject. I, certify that the work as authorized in this special ice permit has been completed and is no~ ready for your inspection. Also, the permit number on.this project is clearly visible. Signed - Owner Signed - Contractor -Date "Board Of SOuth:old Town Trustees SOUTHOLD, NEW YORK' -PERMIT NO. ":.:.J.J.?~J ............... -DATE:Maztch.'.'..8,.~....~..c376 nt'l t ri atinn Pursuianf to.the .provisions of Chap,.er 615 of fhe..Laws of the State' of New york, 1893; and C~apfer 404 of the Laws of State of New York 1952; a,d fhe Soufhold ToW~ Ordinance eh- fffJed "RE~U~TIN~ AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and b accordance with Resolu+io~ of The Board ~dopfed .at a meeting held on ...~a~c~ ....... 1.9. Z.~ .... and in conslderafion of the. sum of $.-.'....~2Z.2.0..:-;p~id by~ ................................ E~...~p.~..~ ................................................... : ...... : ........ :.': ......................... of ....... S.~%~.~.~.~ .................................................... N. Y. ~nd subject fo the 'Terms 'end Conditions listed on '-the Feverse side .... hereof, of Soufhold. ToW~ Trusfe'e~ eufhorizes'and permlfs the' following: ~e~ZssZo~ ¢o ~Zaoe A0'%~"~oo~, ~"~4~, 12~%8 ~Z'o'&¢ o= Goose C~e'e~, ¢_Z~ecCZy ~= ~o~¢ oZ ~s ~o~e~¢~ aC 650 O~k S¢~ee¢, SoU¢:~oZ'~, ail in accordance with the d.efai[ed speclflcafions as present-ed i, the origir~af]ng apptlcaf~on. IN WITNESS WHEREOF, The said Board of Trustees here- by causes ifs Corporate Seal fo b.e affixed a,d ¢-hese presents fo be ' Subscribed by a majorify of f~ said Board. ~s~f fbis daf, e. ' Trustees A/2 ~ Rev. 6/72 BOARD OF TOWN TRUSTEES Town Off Southold l~Iain Road $outhold, New York 11971 APPLICATION FOR FIXED and/or FLOATING DOCKS 2. Contractor's name and address: ...... .~..~.../~..~. ....... ~. ....... .~....~...~..?.~. .............................................. 3. Br e,y explain the p rpo of this opp,ca,on: ..... rA' ...... ...... ........ 4. After issuance of a Permit, I expect to: (mark by an X9 (a) Commence work -- AT ONCE ............ ; ASAP ..... ~....; UNI<NCa/4N ............. ('b) Complete work in 1 DAY ............; 1 ~O ............ ; 1 YR ....~ ...... ; FUTURE ............. Secure the correct Area Map from the Secretary of this Board, (:nd by using an X WITHIN ^ CIRCLE indicate as closely as possible the location of this dock. On the reverse side of this map, 'provide a SCALE DRAWING which will show Ordinary High Water Mark, fha shape and size of the dock and any supplemental pilings which are needed to ham a floating dock or t/e-up a boat. Give all dimensions necessary to determine the area of the dock surface which extends offshore from .the O. H. W. M. 6. Will any portion of this construction .extend offshore i.nto Town Waters beyond an, imagirzcLry IJhe or boundary formed by other similar~ structures along the area's shoreline? YES or ([~J.~ If it does extend beyond this so-called dock line indi~a~-e by how for, approximately,. ......... ft. Provide the following documents: (a) A Licensed Engineer's Survey of '(he property involved. (b) A copy of t'he Contractor's Plans and Specifications. 8. Will this construction require the Filling of any land .offshore of the Ordinar~High Water Mark or the Dredging of a-ny material from Town Land~ unkler water? YES or~. If it does Form A/4 (Application for Dredging/Fill~ing) must be completed and attached as port of thi~ application. a requesting approval of this application, I submit that: the information presented herein is true and correct to the best of my knowledge and belief; I am the person accountable for the performance of the work in accordance with the pbns and specifications attached; I have teac or am familiar with the provisions of any Southold Town Ordinance pertinent to the work involved; and further, I intend to adhere to and abide by the Terms and Conditions of the Permit, when and if issued to me. ~6,ccepted by: ~ /-7~ ~7~